Friday, July 31, 2009

Good idea on the floor: 4:1 nurse ratios. It helps keep the nurses from being overworked. Result for the ER: management wont even consider the much safer 3:1 ER ratio because "we are just following the law".

Good idea on the floor: printing rhythm strips on monitored patients. It proves that someone is paying attention. Result for the ER: Despite the patient's heart rhythm clearly documented on the EKG we just got and their telemetry reading being displayed 2 feet from the doctor's head, I still have to take the time to go print a rhythm strip and sign it.

Good idea on the floor: hourly rounding. It gets the nurses up out of the piles of mandated paperwork and into the patient rooms. Result for the ER: I have to leave my crashing patient in 5 to go fluff the pillow of the ingrown toenail pain in 6 to prove that I'm "customer service oriented"

Good idea for the floor: treatment goal posted on the whiteboard. It gives everybody an idea of what, specifically, that patient is hoping to achieve. Result for the ER: with patients rotating in and out every hour or two, there is no way to keep up with individual goals. The end-product: everybody's white board says "goal: to feel better." Yeah, that's a nice one to have up on the board at the end of a failed code.

Good for the Med Floors: q2h I.V. assessments - we are basically 1:1 or 1:2 with our patients and are usually adjusting some kind of I.V. med q 20-30 mins... we would KNOW if our IV's were messed up... we don't need to be reminded to check them

Good for the Med Floors: Seasonal staffing rules with no vacations in Winter (Florida here!). The "Season" in L&D is around Jul-Oct... so because our hospital INSISTS on ignoring the fact that our "season" is totally opposite from the rest of the hospital, all of our staff is forced to go on vacation when we are drowning, and fully staffed when you can hear a pin drop.

A lot of your examples work the same for us, since we triage & treat most pregnant people after 20 weeks (unless they obviously have a major trauma and are about to die, they come to us)- flu, appendicitis, whatever...

About Braden

"...As the explorers investigated this newfound treasure, they were drawn to the currency of this civilization. Ordinary in appearance but with the words E Pluribus Braden inscribed carefully along the border and with a picture of a strikingly handsome young nurse emblazoned boldly in the center. Truly this must have been a remarkable people..."

Excerpt from "A History of Earth" by Marcus T. Marian. Published by Megadodo Publications, Ursa Minor.

blah blah blah

No, it isn't you I'm talking about. Believe it or not, you are not the only patient who came in the ER with that same complaint in the last year, let alone the last week. Besides, I'm not breaking any HIPAA laws because I'm not divulging any identifying information, and I'm probably combining three cases together and changing the gender and age when I write about that crazy patient anyway.

Besides, even if it is you, do you really want to admit to having done that?